i need help critiquing the article attached below applying criteria outlined by Arshengrau and Seage ( 2008)American Journal of Epidemiology
The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial
License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Role of Tobacco Use in the Etiology of Acoustic Neuroma
Sadie Palmisano, Judith Schwartzbaum, Michaela Prochazka, David Pettersson,
Tommy Bergenheim, Rut Florentzson, Henrik Harder, Tiit Mathiesen, Gunnar Nyberg, Peter Siesjo
and Maria Feychting
Correspondence to Dr. Maria Feychting, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm 171 77,
Sweden (e-mail: [email protected]).
Initially submitted July 6, 2011; accepted for publication November 15, 2011.
Two previous studies suggest that cigarette smoking reduces acoustic neuroma risk; however, an association
between use of snuff tobacco and acoustic neuroma has not been investigated previously. The authors conducted
a case-control study in Sweden from 2002 to 2007, in which 451 cases and 710 population-based controls completed
questionnaires. Cases and controls were matched on gender, region, and age within 5 years. The authors estimated
odds ratios using conditional logistic regression analyses, adjusted for education and tobacco use (snuff use in the
smoking analysis and smoking in the snuff analysis). The risk ofacoustic neuroma was greatly reduced in male current
smokers (odds ratio (OR)
0.41, 95% con±dence interval (CI): 0.23, 0.74) and moderately reduced in female current
0.70, 95% CI: 0.40, 1.23). In contrast, current snuff use among males was not associated with risk of
acoustic neuroma (OR
0.94, 95% CI: 0.57, 1.55). The authors’ ±ndings are consistent with previous reports of lower
acoustic neuroma risk among current cigarette smokers than among never smokers. The absence of an association
between snuff use and acoustic neuroma suggests that some constituent of tobacco smoke other than nicotine may
confer protection against acoustic neuroma.
acoustic neuroma; cigarette smoking; smoking; snuff; snus; Swedish snuff; tobacco; vestibular schwannoma
Abbreviations: CI, con±dence interval; OR, odds ratio; RR, risk ratio; TSNA, tobacco-speci±c nitrosamine.
Acoustic neuroma, also known as vestibular schwannoma, is
a benign, slow-growing tumor affecting Schwann cells of the
eighth cranial nerve. It comprises approximately 8%–10% of all
intracranial tumors (1–3). Schwann cells are peripheral nervous
system cells that produce a myelin sheath around neuronal
axons. Common presenting symptoms for acoustic neuroma
include hearing loss, tinnitus, and lossofbalance; however, large
untreatedtumors can potentially lead to brain stem compression,
hemorrhaging, and death, although these outcomes are rare (4).
Incidence estimates vary from 1 to 20 cases per million per year
(5), with more recent estimates placing incidence between 11
and 13 cases per million per year (2). Although the incidence
appears to be increasing over time (3, 5–7), it is unclear whether
this signals a true increase or is due to improved diagnostic
technology, changes in completeness of reporting, or both.
Several risk factors for acoustic neuroma have been identi-
?ed through previous research. The inherited genetic condi-
tion neuro?bromatosis type 2 has been associated with
bilaterally presenting acoustic neuroma cases; however, these
bilateral tumors account for fewer than 5% of all acoustic
neuroma diagnoses (6). Less is known about the etiology of
acoustic neuroma cases presenting unilaterally, even though
these 1-sided tumors account for the majority of cases. Studies
(8) and atomic bomb survivors (9) have linked moderate to
high doses of ionizing radiation to increased acoustic neuroma
risk. Risk factors including loud noise (10–12), mobile phone
use (13), and some occupational hazards (14) have also been
investigated, but these results have been inconclusive.
Two studies found a protective effect of cigarette consump-
tion on acoustic neuroma risk. Schoemaker et al. (15) noted that
ever smokers were at a reduced risk of acoustic neuroma com-
pared with never smokers (odds ratio (OR)
0.7, 95% con?-
dence interval (CI): 0.6, 0.9), and current smokers enjoyed even
Am J Epidemiol.
Vol. 175, No. 12
Advance Access publication:
April 19, 2012
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